8 things to do after match results

Importance of USMLE Step 2 CS score attempts in Program Interviews

Step 2 CS is an important exam for residency applicants. While American medical graduates do not have any issues passing this exam, many international and foreign medical applicants fail this exam for multiple reasons. Similar articles in the past have dealt with issues like which are the best programs for applicants with attempts in Step 1 and how Step 1 and Step 2 CK score affect interview invitations.

Reasons for failing and importance of Step 2 CS: 

Difficulty with accent, spoken English, customs, problems with comprehension of the standardized patient and unfamiliarity with the medical conduct and bedside manners in US, all contribute to high failure rate in IMGs. Step 2 CS is a pass/fail exam so it is important to clear this exam prior to applying for residency. It is one of the required examinations to get ECFMG certified which in turn is mandatory for residency application, matching and eventually state licensing to practice medicine in US. 

Using data analyzed from the program directors survey an NRMP publication (2012), program specialties were arranged in the order of importance they place on passing step 2 CS when considering applicants for interviews. The results, shown in figure 1, were indeed surprising. 

Fig 1: % of programs that consider step 2 CS result in inviting applicants for  residency interview, Source: NRMP

Results:

1. Highly competitive programs like dermatology, ENT (OTO), ortho, plastic etc did not place much importance on step 2 CS results 

2. Radiology which is competitive and a favorite for foreign trained radiologists was also at the bottom. 

3. Pathology, pediatrics and psychiatry programs (79, 82 and 83% respectively) used step 2 CS scores when considering applicants for interview 

4. Resounding majority of family medicine programs(91%) considered step 2 CS scores when inviting applicants for interviews. 

Discussion: 

The fact that highly competitive programs like Derm, Ortho, ENT etc do not stress much importance in USMLE step 2 CS pass/fail score may be as a result of a combination of factors. They are inherently very difficult residencies to get into with the bar for selection placed very high in other areas (AOA, research, contacts?, networking). All applicants are American graduates with almost 100% pass rates for USMLE step 2CS, which makes considering this exam a criterion less important.     

Radiology may not place much importance on this exam for the simple reason, this is a clinical skills exam and radiology is not a clinical skills field. The irrelevance of step 2 CS for radiology may reflect in its low importance as a factor to grant interviews. 

Looking at FM, IM, pediatrics and psychiatry, FM tends to place the most importance on step 2 CS scores. Thus if you have failed in this exam, it may not be a good idea to apply to FM as vast majority (91%) of programs are going to take your 2CS score into account. There may be other things in your resume, which may help you gain an interview mitigating the effect of a failed step 2 CS but a lot of FM programs seem to place importance on this result. 

Implication: 

Though the difference between IM, FM, Peds, psych, path and neuro are small, they may still be important enough to consider which programs you are going apply to if you have an attempt on your USMLE step 2 CS. 

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Reference:

National Resident Matching Program, Data Release and Research Committee: Results of the 2012 NRMP Program Director Survey. National Resident Matching Program, Washington, DC. 2012.

Proportion Of Interviews, Ranked And Matched Applicants For Primary IMG Friendly Specialties

Using data from the NRMP program results, we find an interesting trend between number of applying candidates, applicants interviews, ranked to a program and matched numbers. The figure below shows the mean number of interviews, ranked and matched applicants in Primary IMG friendly specialties. A similar analysis of secondary IMG friendly specialties has been done and can be read at the link provided.

Figure Key:

• “Interviewed” refers to the average number of applicants a program has interviewed.
• “Ranked” refers to the average number of applicants the program places on their rank order list
• “Matched” refer to the average number of applicants that match into a program. This is generally the number of positions that program has.
• “Primary IMG friendly” program refers to specialties which IMGs apply and are the core group of IM, FM, Peds, Psych. 

  

Fig. 1: Proportion of interviewed, ranked and matched applicants primary IMG (Source NRMP)

As can be seen in the figure, Programs in internal medicine had the highest average number of applicants interviewed. IM also has the highest number of applicants ranked to programs and a high number of applicants that matched. Pediatrics was pretty close to medicine when it came to mean number of applicants interviewed and ranked. Pathology typically is not IMG friendly but was included here to keep the balance of specialties from secondary IMG friendly programs. Family medicine had the least number of applicants interviewed per program amongst the BIG four, ranked per program and matched per program. The numbers in the bars denote the mean number of applicants for respective category. 

What is the implication of this information?

16 applicants are interviewed for one position in Internal Medicine

12 applicants are interviewed for one position in Pediatrics

11 applicants are interviewed for one position in Psychiatry

11 applicants are interviewed for one position in Family Medicine

12 applicants are interviewed for one position in Pathology

Thus to maximize chances in matching in say, FM you likely need 11 interviews and so forth. This is the mean and numbers can be different for individual programs. This is slightly different for IM because by that comparison, one would say, 'you need 16 interviews to secure a match to at least one program'. There are 2 off shoots of this statement, one, you do not need 16 and any number between 10 and 15 should do the job. This explained by the fact that residency match is not a straight mathematical probability problem, the human element plays a big role. Second, there is a strange trend of having 15+ interviews and the rate of matching going down this has a few possible reasons as well which are discussed in article link provided.

If some one has the above number of interviews, then the chance of matching is exceptionally strong. However, you only need one interview to match because, if you ace that one interview, you can still be ranked at the top of a program ROL and match into that program. Therefore if you do not get as many interviews, do not be disheartened instead focus on the few you have! If you wish to be in touch and get the latest posts and updates, join me on Facebook or follow me on Twitter. Also Scroll below ↓ for the most popular articles this week!

Proportion Of Interviews, Ranked And Matched Applicants For Secondary IMG Friendly Specialties

Using data from the NRMP program results, we find an interesting trend between number of applying candidates, applicants interviews, ranked to a program and matched numbers. The figure below shows the mean number of interviews, ranked and matched applicants in secondary IMG friendly specialties. A similar analysis of primary IMG friendly specialties has been done and can be viewed at the link provided.

• “Interviewed” refers to the average number of applicants a program has interviewed.
• “Ranked” refers to the average number of applicants the program places on their rank order list
• “Matched” refer to the average number of applicants that match into a program. This is generally the number of positions that program has.
• “Secondary IMG friendly” program refers to specialties which IMGs apply to but are not the core group of IM, FM, Peds, Psych.

Fig. 1: Proportion of interviewed, ranked and matched applicants (Source NRMP)

As can be seen in the figure, Programs in anesthesia had the highest average number of applicants interviewed. Anesthesia also has the highest number of applicants ranked to programs and highest applicants that matched. Compared to radiology, Ob gyn and surgery, which occupied a central position, Neurology had the least number of applicants interviewed per program, ranked per program and matched per program. The numbers in the bars denote the mean number of applicants for respective category. 

What is the implication of this information?

16 applicants are interviewed for one position in Radiology

13 applicants are interviewed for one position in Anesthesia

12 applicants are interviewed for one position in Ob-Gyn

12 applicants are interviewed for one position in Surgery

12 applicants are interviewed for one position in Neurology

Thus to maximize chances in matching in radiology you likely need 16 interviews, anesthesia 13 interviews, Obgyn, surgery and neurology are at 12 interviews each. This is the mean and numbers can be different for individual programs.

If some one has the above number of interviews, then the chance of matching is exceptionally strong. However, you only need one interview to match because, if you ace that one interview, you can still be ranked at the top of a program ROL and match into that program. Therefore if you do not get as many interviews, do not be disheartened instead focus on the few you have! If you wish to be in touch and get the latest posts and updates, join me on Facebook or follow me on Twitter. Also Scroll below ↓ for the most popular articles this week!

Step 2 CK Score and Chances of Interview - Residency

USMLE Step 1 score has been analyzed in a previous article and while step 1 is a huge factor is deciding the interviews and match chances, step 2 CK scores are often just as important. In fact, the two scores together can decide for most part if you will be called for an interview. Analysis of the program directors survey by NRMP yields very interesting results for how step 2 CK scores affect your chances of interview and subsequently residency.

Fig 1: Step 2 CK score and chances of interview| source @ NRMP

The graph in figure 1 shows a ‘stock chart’ indicating the high, low and the mean scores. The subjects are arranged in the order of increasing average scores. Scores that lie along the red line are the ‘lows’, which reflect the scores below which the programs DO NOT offer interviews to residency applicants. On the other hand, the scores along the blue line reflect the ‘highs’, which are scores above which the programs usually offer interviews for applicants.

One must be careful to interpret this data because this is a composite of all applicants. The values are lower than those required of by the international medical graduates because they also include scores and data of graduates of American medical schools. An important facet of this result is, if you have scores lower than 195 in step 2 CK, then the chances of getting interviews in ANY specialty is very poor. However, there are inter-subject differences that are also apparent on this graph. Psychiatry, family medicine and pediatrics do not per say place that much importance on step 2 scores in comparison to internal medicine, pathology or radiology.

For applicants that lie in between the blue and red lines, the success of their application may depend on other factors.  These other issues are dealt in depth in respective segments of the website.

Conclusions: 

1. Scores below 195 are very unfavorable for any specialty
2. If you score poorly on step 2 CK, then there may be a better chance in family medicine, psychiatry or pediatrics
3. Conversely, if you are interested in radiology or pathology then getting high scores on Step 2 CK is must
4. Applicants who score 245+ can safely expect a few interviews irrespective of the subject they have applied. This is more so in case of pediatrics, family medicine and psychiatry.

One must realize that scores are but one factor in the whole match process and should not affect your choice of applying for match. There are other things in your resume which can make a positive impact in your application process like research, USCE, observerships, volunteer work and other achievement can often help you just as much as scores.
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Sample transcript of biostatistics for research

Biostatistics is covered under preventive and social medicine in the medical curriculum. If you are considering applying for research either as an alternative career for an IMG or as a work experience to enhance your CV, it is important to document that you have been trained in basic statistical techniques. Some graduate schools may have a requirement to have basic biostats prior to enrolling for some advanced courses and in this case, it can be a huge time and money saver to have the proof of biostats from your medical college. If you are looking for a research job, having this certificate in your file will certainly help your chances. While it not a standard practice for medical schools or colleges to provide a certificate of completion of stats course, it is not difficult to get a certificate from the department using the department letterhead/stationary proving that you have finished a course in statistics as part of your training in medicine. Shown below is an example of such a certificate which you can create for yourself.

Sample certificate detailing completion of biostats

the unformatted text is also presented here in case you wish to use it for your own purpose.

 

This is to certify that below mentioned prescribed courses were attended by __________ in the subject of Biostatistics as part of the subject of preventive and social medicine for his/her degree of M.B.B.S of University of _______________. These topics have been covered in the final academic year of the MBBS course and he/she has performed satisfactorily in the course.

TRANSCRIPT

Topic	Hours
Data collection	2
Classification and tabulation of data	2
Presentation of statistical data	4
Standard deviation	2
Normal distribution	2
Standard error of mean and proportion	4
Standard error of difference between means and proportions	4
Paired ‘t’ test	2
Unpaired ‘t’ test	2
x2 tests	4
Vital statistics	2
Common statistical fallacies and problems	2
Total	32

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The best programs for applicants with multiple attempts on step 1

Step 1 is exceptionally powerful indicator of opportunities of interview. One cannot emphasize how important it is to score well on the step 1. However in spite of the best of efforts many international and American medical graduates are faced with the misfortune of not passing the step 1 in the first attempt. This could be for any number of personal, professional or even medical reasons. How does having an attempt in step 1 affect your interview chances? Are there particular specialties that someone with attempts must avoid in order to improve their chances of securing an interview and subsequent match? What programs to apply if there is an attempt to step 1? The following graphs answers those questions

Specialties and programs that will not invite applicants with attempts


As seen from the figure 1, there was a lot of variation amongst the specialties and programs regarding their outlook towards applicants with multiple attempts in Step 1. The difference is obvious as the trend shifts towards surgical specialties.


Dangerous specialties for applicants with attempts in step 1
Surgical specialties seemed unsafe for applicants with attempts in step 1. General surgery was on the top of the list with 45% of programs saying they will not interview applicants with more than one attempt on step 1, this was followed surprisingly by anesthesia at 28% and pathology at 24%. Ob- Gyn was at the bottom with 21% on par with medical specialties.


Middle tier
Neurology, Internal Medicine (IM) and emergency medicine (EM) were the middle rung with a range from 16% to 21% of programs refusing to grant interview to applicants with attempts.


Less dangerous specialties for applicants with attempts in step 1
These are family medicine, psych and pediatrics. Only 3 to 6% of these programs refused to grant interviews for applicants with multiple attempts on step 1




Specialties and programs that will most often invite applicants with attempts

Figure 2 is even more revealing about the workings of the programs when it comes to granting interviews. This graph shows how often a program will invite applicants with attempts of step 1 based on specialty.


Unsafe specialties
Neurology, Surgery and anesthesia are amongst this category. They were least often prepared to invite applicants with attempts in step one.


Moderately safe
This is the same middle tier with IM and EM as above with the exception of neurology. So if you have attempts on step 1 then you will hear from these programs anywhere from 10 to 18% of the time. Even Pathology and Ob-Gyn programs said they will often interview candidates with attempt 12 to 18% of time.


Very safe
This is the clincher. Family medicine will invite applicants with attempts up to 50% of time. This is followed by psychiatry and pediatrics at 37 and 25% respectively.


Conclusion
- the best specialties to apply for applicants with attempt in step 1 are Family medicine, psychiatry and pediatrics.
- Neurology though excluded candidates with attempts only 20% of time, invited applicants with attempts only 3% of time.
- Internal medicine was a stable middle tier choice.


This article will help focus your application to the right place, while you are scoping out your competition.